Asunto(s)
Complicaciones Intraoperatorias/terapia , Guías de Práctica Clínica como Asunto , Escoliosis/cirugía , Traumatismos de la Médula Espinal/terapia , Fusión Vertebral/efectos adversos , Adolescente , Adulto , Algoritmos , Niño , Terapia Combinada , Contraindicaciones , Drenaje , Humanos , Hipotermia Inducida , Fijadores Internos/efectos adversos , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/prevención & control , Hipertensión Intracraneal/cirugía , Complicaciones Intraoperatorias/tratamiento farmacológico , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Isquemia/etiología , Isquemia/prevención & control , Isquemia/terapia , Metilprednisolona/uso terapéutico , Monitoreo Intraoperatorio/métodos , Monitoreo Intraoperatorio/estadística & datos numéricos , Fármacos Neuroprotectores/uso terapéutico , Médula Espinal/irrigación sanguínea , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/prevención & controlRESUMEN
May-Thurner syndrome consists of the compression of the left iliac vein by the right iliac artery. We present the case of a 13-year-old girl with severe scoliosis and May-Thurner syndrome that became evident during surgery to correct the scoliosis. An initial attempt to treat the scoliosis employed a posterior approach using Isola instrumentation; however, the procedure was aborted due to the presence of enormous dilated perimedullary veins and hemorrhage. Angiography and venography confirmed the diagnosis of May-Thurner syndrome. Given the patient's age, the condition was not treated with an endovascular stent. She is currently awaiting definitive treatment. This is the first case in the literature in which varicose dilatation of the perimedullary veins in the spinal canal interfered with the surgical treatment of scoliosis. This case underlines the potential difficulties of surgery in the presence of myriad dilated perimedullary veins. May-Thurner syndrome should be suspected in scoliotic patients with dilated perimedullary veins.
Asunto(s)
Vena Ilíaca , Escoliosis/complicaciones , Escoliosis/cirugía , Enfermedades Vasculares/etiología , Adolescente , Femenino , Humanos , Arteria Ilíaca , Hallazgos Incidentales , SíndromeRESUMEN
El síndrome de May-Thurner (M-T) consiste en la compresión de la vena iliaca izquierda por la arteria iliaca derecha. Presentamos el caso de una niña de 13 años con escoliosis severa y síndrome de M-T, que se evidenció tras una complicación durante la cirugía correctora de la escoliosis. El tratamiento inicial consistió en un abordaje posterior e instrumentación de Isola, pero fue concluido de manera prematura por la presencia de enormes venas perimedulares dilatadas y hemorragia. Se realizó una angiografía y flebografía diagnosticándose un síndrome de May-Thurner. Dada la edad de la paciente no se realizó tratamiento endovascular con stent. La paciente se encuentra a la espera de tratamiento definitivo. No existen casos en la literatura de dilatación varicosa de las venas perimedulares en el canal espinal que interfieran el tratamiento quirúrgico de la escoliosis. Este caso subraya la dificultad potencial de la técnica quirúrgica en presencia de una miríada de venas perimedulares dilatadas. El síndrome de May-Thurner debería sospecharse en pacientes escolióticos con venas perimedulares dilatadas (AU)
May-Thurner syndrome consists of the compression of the left iliac vein by the right iliac artery. We present the case of a 13-year-old girl with severe scoliosis and May-Thurner syndrome that became evident during surgery to correct the scoliosis. An initial attempt to treat the scoliosis employed a posterior approach using Isola instrumentation; however, the procedure was aborted due to the presence of enormous dilated perimedullary veins and hemorrhage. Angiography and venography confirmed the diagnosis of May-Thurner syndrome. Given the patient's age, the condition was not treated with an endovascular stent. She is currently awaiting definitive treatment. This is the first case in the literature in which varicose dilatation of the perimedullary veins in the spinal canal interfered with the surgical treatment of scoliosis. This case underlines the potential difficulties of surgery in the presence of myriad dilated perimedullary veins. May-Thurner syndrome should be suspected in scoliotic patients with dilated perimedullary veins (AU)
Asunto(s)
Humanos , Femenino , Niño , Escoliosis/complicaciones , Escoliosis/cirugía , Escoliosis , Vena Ilíaca/patología , Vena Ilíaca , Flebografía/métodos , Flebografía/tendencias , /métodos , Angiografía/métodos , Angiografía/tendencias , AngiografíaRESUMEN
We report our first performance of a multiple anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon. In the last 2 years, video-assisted thoracoscopy has been introduced as a new therapeutic technique in the field of spinal diseases. Its use has been most documented in the treatment of vertebral abscesses and disc herniations, while its performance in treating deformities is less known. The patient in our case was an 11-year-old boy with a 7-year history of aggressive left thoracic idiopathic scoliosis that had previously needed three subcutaneous instrumentations and finally a Cotrel-Dubousset-instrumented arthrodesis. Following these operations, a continuous clinical and radiographical evolution of the curve was recorded and an anterior T6-T11 video-assisted thoracoscopic epiphysiodesis was therefore performed. The patient did not need postoperative narcotics; Argyle chest tubes were removed after 48h with only 150ml of serohaematic drainage, no blood transfusion was required. One year after the intervention, we found a well-consolidated T6-T11 arthrodesis with no evolution of the deformity. The endoscopic technique allowed us to perform an extensive anterior arthrodesis using only three small incisions, with a reduction of bed-confinement to 3 days and reduced postthoracotomy pain.
